,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #gdgh  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,febru>y #aj1         
#bjbf,mr4 ,vasquez 7= himself1 ,ms4     
,/ansbury1 ,mr4 ,ruiz1 ,ms4 ,ca/or (    
,florida1 ,mr4 ,?an$>1 ,ms4 ,cl>ke (    
,new ,york1 ,ms4 ,s*ri]1 ,mr4 ,g>cia (  
,cali=nia1 ,ms4 ,b>ragn1 ,mr4 ,l&sman1  
,mr4 ,fro/1 ,ms4 ,norton1 ,ms4 ,craig1  
,mr4 ,g>ca ( ,ill9ois1 ,ms4 ,simon1 ,mr4
 ,goldman ( ,new ,york1 ,mr4 ,hors=d1 & 
,ms4 ,del,bene7 introduc$ ! foll[+ bill2
 :i* 0 ref]r$ to ! ,committee on ,en]gy 
& ,comm]ce1 & 9 addition to ! ,committee
 on ,ways & ,means1 = a p]iod to be     
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
e/abli% c]ta9 /&>ds & requirem5ts )     
respect to f9ancial assi/ance & m$ical  
debt collection = hospitals p>ticipat+ 9
 ! ,m$ic>e program1 & to am5d title     
,,iii ( ! ,public ,heal? ,s]vice ,act to

 e/abli% a grant program = purposes (   
m$ical debt relief4  #a4 ,%ort title    
,?is ,act may be cit$ z ! ,pati5t ,debt 
,relief ,act4  #b4 ,e/abli%+ /&>ds &    
requirem5ts ) respect to f9ancial       
assi/ance & m$ical debt collection z    
condition ( p>ticipation 9 ! ,m$ic>e    
program ,section #ahff ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acie;cc7 
is am5d$-- 7#a7 9 subsection 7a77#a7--  
7,a7 9 subp>agraph 7,x71 by /rik+ & at !
 end2  7,b7 9 subp>agraph 7,y71 by /rik+
 ! p]iod at ! end & ins]t+ 1 &2 &  7,c7 
by ins]t+ aft] subp>agraph 7,y7 ! foll[+
 new subp>agraph3  7,z7 9 ! case ( a    
hospital1 beg9n+ ,janu>y #a1 #bjbh1 to  
comply ) ! f9ancial assi/ance & debt    
collection requirem5ts describ$ 9       
subsection 7l74  2  7#b7 9 subsection   
7b71 by add+ at ! end ! foll[+ new      
p>agraph3  7#e7 7,a7 ,a hospital t fails
 to comply ) ! requirem5ts ( subsection 
7a77#a77,z7 7relat+ to f9ancial         
assi/ance & debt collection7 is subject 
to a civil monet>y p5alty "u ?is        

p>agraph4  7,b7 ,! ,secret>y may impose 
a civil monet>y p5alty 9 an am\nt       
specifi$ by ! ,secret>y 7b n to exce$   
#a1jjj1jjj7 = ea* in/ance (             
noncompliance ) ! requirem5ts (         
subsection 7a77#a77,z71 z det]m9$ by !  
,secret>y1 if-- 7i7 n lat] ?an #ij days 
aft] ! date on :i* ! ,secret>y det]m9es 
su* noncompliance exi/s1 ! ,secret>y    
submits to su* hospital a notification (
 su* det]m9ation2 &  7ii7 z ( ! date t  
is #de days aft] su* notification is    
s5t1 ! ,secret>y det]m9es t su* hospital
 has n tak5 mean+ful actions to come    
into compliance ) su* requirem5ts4  ,!  
provisions ( section #aabh;,a 7o!r ?an  
subsections 7a7 & 7b77 %all apply to a  
civil monet>y p5alty "u ?is p>agraph 9 !
 same mann] z su* provisions apply to a 
p5alty or proce$+ "u section            
#aabh;,a7a74  2 &  7#c7 by add+ at ! end
 ! foll[+ new subsection3  7l7 ,f9ancial
 assi/ance & debt collection requirem5ts
  7#a7 ,9 g5]al ,= purposes ( subsection
 7a77#a77,z71 ! f9ancial assi/ance &    

debt collection requirem5ts are1 )      
respect to a hospital-- 7,a7 ! f9ancial 
assi/ance & *>ity c>e requirem5ts       
describ$ 9 p>agraph 7#b72 &  7,b7 !     
m$ical debt collection limitations      
describ$ 9 p>agraph 7#c74  7#b7         
,f9ancial assi/ance & *>ity c>e         
requirem5ts ,= purposes ( p>agraph 7#a71
 ! requirem5ts describ$ 9 ?is p>agraph  
are1 ) respect to a hospital1 ! foll[+3 
7,a7 ,! hospital-- 7i7 has e/abli%$ a   
*>ity c>e or f9ancial assi/ance policy2 
7ii7 has e/abli%$ m9imum eligibility    
requirem5ts ) respect to su* *>ity c>e  
or f9ancial assi/ance policy1 & has made
 su* requirem5ts publicly available2 &  
7iii7 has e/abli%$ a process = scre5+   
individuals furni%$ items or s]vices by 
! hospital to det]m9e :e!r ea* su*      
individual may be eligible = assi/ance )
 respect to paym5t = su* items or       
s]vices pursuant to su* *>ity c>e or    
f9ancial assi/ance policy4  7,b7 ,)     
respect to items or s]vices furni%$ by !
 hospital to an individual :o has appli$

 = *>ity c>e or f9ancial assi/ance "u ! 
policy describ$ 9 subp>agraph 7,a77i71 !
 hospital-- 7i7 det]m9es1 n lat] ?an #cj
 days be=e ! date on :i* paym5t = su*   
items or s]vices is due1 :e!r su*       
individual is eligible = assi/ance )    
respect to su* paym5t pursuant to su*   
*>ity c>e or f9ancial assi/ance policy2 
7ii7 9 ! case t a hospital det]m9es     
pursuant to clause 7i7 t an individual  
is ineligible = su* *>ity c>e or        
f9ancial assi/ance policy ) respect to  
su* paym5t1 p]mits su* individual to    
appeal su* det]m9ation2 &  7iii7 does n 
seek to collect su* paym5t f su*        
individual until ! det]m9ation "u clause
 7i7 ) respect to su* individual has be5
 made4  7,c7 ,! hospital includes ) any 
bill = paym5t ) respect to items or     
s]vices furni%$ by ! hospital to an     
individual-- 7i7 ! m9imum eligibility   
requirem5ts describ$ 9 subp>agraph      
7,a77ii7 ) respect to ! *>ity c>e or    
f9ancial assi/ance policy ( ! hospital2 
7ii7 notice ( ! m$ical debt collection  

limitations describ$ 9 p>agraph 7#c71   
includ+ ! repaym5t program describ$ 9   
subp>agraph 7,c77ii7 ( su* p>agraph2 &  
7iii7 in/ructions = ! individual to     
submit to ! hospital any in=mation t    
w\ld be necess>y = ! hospital to make a 
det]m9ation ) respect to ! h\sehold     
income ( su* individual at ! "t su*     
items or s]vices 7 furni%$ = purposes ( 
c>ry+ out subp>agraph 7,d7 ( su*        
p>agraph4  7#c7 ,m$ical debt collection 
limitations ,= purposes ( p>agraph 7#a71
 ! limitations describ$ 9 ?is p>agraph  
are1 ) respect to a hospital & m$ical   
debt ow$ to ! hospital by an individual1
 t-- 7,a7 ! hospital does n seek to     
place a li5 on or =eclose ^u ! home (   
su* individual 9 ord] to collect su*    
m$ical debt2  7,b7 ! hospital does n    
seek to g>ni% ! wages ( su* individual 9
 ord] to collect su* m$ical debt2  7,c7 
subject to subp>agraph 7,d77ii71 !      
hospital does n sell or assign su*      
m$ical debt to a debt collector unless--
 7i7 m ?an #a ye> has elaps$ s9ce ! date

 on :i* paym5t = su* items or s]vices 0 
due2  7ii7 ! hospital makes available to
 ! individual a repaym5t program "u :i* 
! individual may make m9imum mon?ly     
paym5ts 7provid$ t ea* su* paym5t does n
 exce$ #d p]c5t ( ! gross mon?ly income 
( su* individual7 t[>d ! m$ical debt1 & 
su* individual fails to make #d or m    
consecutive mon?ly paym5ts "u su*       
repaym5t program or o!rwise decl9es to  
p>ticipate 9 su* repaym5t program2 &    
7iii7 su* debt collector agrees to abide
 by ! limitations describ$ 9            
subp>agraphs 7,a7 & 7,b7 = su* hospital 
) respect to su* m$ical debt2 &  7,d7 9 
! case t ! hospital has receiv$ !       
necess>y in=mation to make ! det]m9ation
 describ$ 9 p>agraph 7#b77;,c77iii71 if 
! hospital det]m9es t ! h\sehold income 
( su* individual 0 n 9 excess ( #bej    
p]c5t ( ! pov]ty l9e = ! size ( ! family
 involv$ = ! mo/ rec5t taxable ye> at ! 
"t ! items or s]vices t are ! subject ( 
su* m$ical debt 7 furni%$1 ! hospital-- 
7i7 does n impose an annual int]e/ rate 

) respect to su* paym5t2 &  7ii7 does n 
sell or assign su* m$ical debt to a debt
 collector4  7#d7 ,monitor+ compliance  
7,a7 ,audits ,beg9n+ ,janu>y #a1 #bjbi1 
& n less frequ5tly ?an annually !reaft]1
 ! ,secret>y %all conduct an audit ( a  
r&om sample ( hospitals to det]m9e :e!r 
ea* su* hospital is 9 compliance ) !    
requirem5ts ( p>agraph 7#a74  7,b7      
,onl9e portal ,n lat] ?an ,janu>y #a1   
#bjbh1 ! ,secret>y %all e/abli% a secure
 int]net website portal 7or o!r         
successor te*nology7 to p]mit           
individuals to report ! noncompliance ( 
a hospital ) ! requirem5ts ( p>agraph   
7#a71 includ+ noncompliance ) !         
limitations describ$ 9 subp>agraphs 7,a7
 & 7,b7 ( p>agraph 7#c7 ( a debt        
collector to :i* ! hospital has sold or 
assign$ m$ical debt4  7#e7 ,def9itions  
,9 ?is subsection3 7,a7 ,debt collector 
,! t]m debt collector has ! mean+ giv5  
su* t]m 9 section #hjc7f7 ( ! ,fair     
,debt ,collection ,practices ,act 7#ae  
,u4,s4,c4 #afib;a7#f774  7,b7 ,m$ical   

debt ,! t]m m$ical debt means1 ) respect
 to items or s]vices furni%$ by a       
hospital to an individual1 ! debt 7z    
def9$ 9 section #hjc7e7 ( ! ,fair ,debt 
,collection ,practices ,act 7#ae        
,u4,s4,c4 #afib;a7#e777 ( su* individual
 = su* items or s]vices4  4  #c4 ,m$ical
 debt relief program ,"p ,p ( title     
,,iii ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #bhj;g et seq47 is am5d$ 
by add+ at ! end ! foll[+ new section3  
#cii,v-#h4 ,m$ical debt relief grant    
program  7a7 ,9 g5]al ,n lat] ?an #a ye>
 aft] ! date ( ! enactm5t ( ?is section1
 ! ,secret>y %all e/abli% a program "u  
:i* ! ,secret>y may make grants to n m  
?an #a eligible nonpr(it organization to
 acquire & dis*>ge ! m$ical debt 7z     
def9$ by ! ,secret>y7 ( eligible        
individuals 9 accordance ) ?is section4 
7b7 ,application ,an eligible nonpr(it  
seek+ a grant "u ?is section %all submit
 an application at su* "t1 9 su* =m1 &  
conta9+ su* in=mation z ! ,secret>y may 
require4  7c7 ,use ( funds ,am\nts      

provid$ "u a grant "u ?is section %all  
be us$ to-- 7#a7 id5tify eligible       
individuals2 &  7#b7 acquire & dis*>ge !
 m$ical debt ( su* individuals4  7d7    
,notice & report+ requirem5ts  7#a7     
,notice requirem5t ,n lat] ?an #fj days 
aft] an eligible nonpr(it organization t
 has receiv$ a grant "u ?is section     
acquires & dis*>ges ! m$ical debt ( an  
eligible individual "u subsection 7c71  
su* eligible nonpr(it organization %all 
notify su* individual ( su* acquisition 
& dis*>ge4  7#b7 ,report+ requirem5t ,n 
less frequ5tly ?an once p] cal5d> qu>t]1
 an eligible nonpr(it organization t has
 receiv$ a grant "u ?is section %all    
submit to ! ,secret>y a report conta9+ !
 foll[+ in=mation ) respect to ! prec$+ 
cal5d> qu>t]3 7,a7 ,! actions tak5 by ! 
eligible nonpr(it organization to       
id5tify eligible individuals4  7,b7 ,!  
numb] ( eligible individuals ^: m$ical  
debt 0 acquir$ & dis*>g$ by ! eligible  
nonpr(it organization1 & ! am\nt (      
m$ical debt s acquir$ & dis*>g$4  7,c7  

,su* o!r in=mation z ! ,secret>y may    
require4  7e7 ,def9itions ,9 ?is        
section3 7#a7 ,eligible individual ,!   
t]m eligible individual means an        
individual ) m$ical debt if1 = ! mo/    
rec5t taxable ye>-- 7,a7 su* m$ical debt
 is equival5t to #e p]c5t or m ( !      
modifi$ adju/$ gross income ( su*       
individual2 or  7,b7 ! h\sehold income (
 su* individual is n 9 excess ( #djj    
p]c5t ( ! pov]ty l9e = ! size ( ! family
 involv$4  7#b7 ,eligible nonpr(it      
organization ,! t]m eligible nonpr(it   
organization means a nonpr(it           
organization ) ! mission ( reliev+      
individuals ( _! m$ical debt1 z det]m9$ 
by ! ,secret>y4  7#c7 ,,irc t]ms ,! t]ms
 h\sehold income1 modifi$ adju/$ gross  
income1 & pov]ty l9e h ! mean+ giv5 ea* 
su* t]m 9 section #cf;,b ( ! ,int]nal   
,rev5ue ,code ( #aihf 7#bf ,u4,s4,c4    
#cf;,b74  7f7 ,fund+ ,!re is au?oriz$ to
 be appropriat$ = purposes ( c>ry+ out  
?is section #ajj1jjj1jjj = fiscal ye>   
#bjbg1 to rema9 available until exp5d$4 

4